Distinct antibody responses to SARS-CoV-2 in children and adults across the COVID-19 clinical spectrum

Farber and colleagues report distinct antibody responses to SARS-CoV-2 in pediatric cohorts, including those who developed multisystem inflammatory syndrome (MIS-C), and adult COVID-19 cohorts. Clinical manifestations of COVID-19 caused by the new coronavirus SARS-CoV-2 are associated with age(1,2). Adults develop respiratory symptoms, which can progress to acute respiratory distress syndrome (ARDS) in the most severe form, while children are largely spared from respiratory illness but can develop a life-threatening multisystem inflammatory syndrome (MIS-C)(3-5). Here, we show distinct antibody responses in children and adults after SARS-CoV-2 infection. Adult COVID-19 cohorts had anti-spike (S) IgG, IgM and IgA antibodies, as well as anti-nucleocapsid (N) IgG antibody, while children with and without MIS-C had reduced breadth of anti-SARS-CoV-2-specific antibodies, predominantly generating IgG antibodies specific for the S protein but not the N protein. Moreover, children with and without MIS-C had reduced neutralizing activity as compared to both adult COVID-19 cohorts, indicating a reduced protective serological response. These results suggest a distinct infection course and immune response in children independent of whether they develop MIS-C, with implications for developing age-targeted strategies for testing and protecting the population.

Automated summary

This study found distinct antibody responses in children and adults after SARS-CoV-2 infection. Adult COVID-19 cohorts showed a broader range of antibody responses, while children predominantly generated antibodies specific for the S protein and had reduced neutralizing activity compared to adults.